Carpal tunnel syndrome

Carpal tunnel syndrome is basically a pinched nerve (the median nerve) at the wrist, in a fixed-volume structure called the carpal tunnel. Pressure can increase in the tunnel for various reasons, resulting in the nerve becoming entrapped and damaged.

What causes carpal tunnel syndrome?

Most cases are related to swelling around the flexor tendons in the wrist. This can be secondary to inflammation, diabetes, thyroid disease, arthritis, pregnancy or overuse of the wrist with repetitive wrist movements or gripping.

What are the symptoms?

Patients complain of pain and burning sensation in the hand and fingers, at night or in the early morning. As the condition progresses, patients experience these symptoms with benign activities, like driving, or reading the paper. Over time, they start loosing sensation in the thumb, index and middle fingers. Loss of muscle tone and power in the thumb can follow.

How to diagnose it?

Clinical examination is performed by your hand surgeon and shows positive:

Tinel’s test: Tapping the skin over the nerve at the wrist reproduces the symptoms.

Phalen’s test: When the patient keeps the wrist flexed for a little while, symptoms are reproduced.

Sensation or feeling disturbance in fingers.

Muscle weakness in the thumb

Additional tests

Electrodiagnostic tests (EMG) are used to assess the severity of the condition and rule out another cause for the symptoms.

Cortisone injection can be helpful to diagnose when the EMG is negative in spite of a high clinical suspicion.

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Functional treatment

Night splinting of the wrist and rest can alleviate the symptoms early. A cortisone injection can be a temporary measure for patients who cannot have carpal tunnel surgery.

Surgery

There are two acceptable procedures:

Open procedure: The open procedure involves an approximately 3 to 4 centimeter incision in the palm. The skin, subcutaneous tissue palmar muscle, and finally the transverse carpal ligament are divided to relieve pressure on the median nerve.

Endoscopic procedure: a very small incision at the wrist or forearm allows to inspect the inside of the carpal tunnel with a mini camera and to divide the transverse carpal ligament only, leaving the skin, subcutaneous tissue and muscle intact. This is the least invasive surgical method and allows a much quicker recovery than the open procedure.